Alyssa Battipaglia LMFT

Have you ever found yourself saying the words, “I feel so fat!”??

 

Did you know those very difficult emotions stem from weight stigma in our culture? Demonizing fatness can sometimes be a tool that allows us to cope with difficult emotions.

 

Let’s uncover what “feeling fat” might really mean and a more helpful way to approach these incredibly valid emotions without putting down anyone’s shape and size.

 

When you say “I feel so fat,” perhaps you mean…

 

“I feel bloated.”

 

Bloating is a perfectly normal part of being a human being. It’s super important to normalize normal fluctuations in the body changes during the day, so that we can all have a more realistic expectation of what it’s like to live in our bodies. But bloating is temporary and will go away over time– which is not the same as fatness!

 

“I feel sluggish.”

 

Sometimes, we say “I feel fat” when what we’re really feeling is sluggish, lazy, lethargic or we have not moved our bodies much that day. Instead of reaching for those more authentic emotions or sensations, we are quick to conflate fatness with laziness. And FYI, that’s not true! Fat people can be active just as much as skinny people can be lazy. Lets try not to assume someone’s activity level purely based on their outward appearance!

 

“I feel insecure.”

 

There are moments when “feeling fat” tends to become a blanket term for our gloominess or misery. What is really plaguing our minds is possibly the fear of being not enough or being undeserving. This is not about feeling fat at all– it’s about grappling with a lack of self-confidence. So imagine how actual fat folks feel when people use their bodies to describe their misery? Humans in all body shapes, sizes and weights can be good enough, deserving and confident.

 

“I feel unattractive.”

 

We all have days when we’re dissatisfied with our own image. We’re followed by a creeping certainty that we’re ugly, unattractive, undesirable or unlovable. But when we say we’re

“Feeling fat,” the implication is clear– fat people are impossible to love or want. Which, AGAIN, is so so so far from the truth.

 

Fat is not a feeling.

 

While it is true that most of us can grip onto a part of our body that contains body fat and experience a physical sensation, the feeling itself is not “fat.”

 

In my professional experience, I find you are much more likely to get the support you need around your feelings if you share how you really feel rather than saying you feel fat. By diving deeper to uncover what is truly under the term “I feel fat,” you fight against diet culture and weight stigma, while also addressing the underlying emotion which promotes healing.

 

So please remember, fat is not a feeling!

Dr. Joy Zelikovsky

A common phrase that people hear in eating disorder treatment is “recovery isn’t linear.” Often it feels like people take one step forward just to take three steps back, or that they feel like they are progressing in one area, but they are having ambivalence or intrusive thoughts that are conflicting with their desire to recover and therefore they are not in “real recovery,” whatever that means anyway. When this happens people are left questioning if the work they have done towards their recovery is valid, or if they are even in recovery at all?

I was working with a client today and they told me that they had received news that something they had been attempting to resolve medically had not resolved. They had discussed it with their medical team and the medical team felt that a medication needed to be adjusted. They discussed it with their dietitian and the dietitian felt like the answer was more nutrition rehabilitation and the issue would resolve. The client shared that they were frustrated as a part of them hoped that it was a medication issue, and they wouldn’t need to eat any more than they were already doing. And then they shared that they were disappointed in having that thought as it meant they were not really working on recovery as if they were they wouldn’t be disappointed that they would have to potentially eat more.

I’ve heard some variation of this scenario a million times from clients. They are working very hard in recovery, but they don’t want to eat more, or they don’t want to do something that is challenging for them and they or sometimes their family/friends/team, question their commitment to recovery. But the reality is that these thoughts are normal! It’s so incredibly normal to experience ambivalence when working on recovery. It’s normal to have setbacks or the feel like you’ve stepped off the path, or at times to feel that you need to take a break from the path and pause where you are for a moment. None of the negates the work you have done or means that you are no longer in recovery.

There are many reasons why eating disorder recovery work is difficult, here are a few that may provide insight into why folks may have a desire to hold onto the eating disorder; even while they are working hard to recover:

1. Comfort in Familiarity: The eating disorder may be the primary coping mechanism for many and the idea of giving it up may be terrifying. For some, the idea of life without an eating disorder is so foreign that it’s inconceivable and feels totally undoable. Some people will still venture forth, others may choose a harm reduction path that better meets their needs.
2. Fear of Change: Eating disorders are highly linked to anxiety. For many, even the prospect of a positive change can still create so much anxiety that it feels paralyzing. This is where having a supportive team and trying to find other positive supports like family, and friends can help make this transition more bearable.
3. Sense of Identity: Often people can create an identity around their eating disorder. It has taken over their lives to the point that they do not know who they are without it. Therefore, the idea of giving it up also leaves them without an identity which can feel equally as scary. Who am I without this thing that has helped me through so much, even if it is also harming me?
4. For some the risk of failure is so prevalent that they feel like they don’t want to try at all – the devil you know is better than the devil you don’t. Therefore, it’s better to stay in the eating disorder even though it’s harming them, rather than risk recovery and relapsing or recovery being worse than their life with their eating disorder.

Why Accepting Ambivalence Is Important

Having conflicting feelings during recovery is not a sign of failure or lack of commitment. It is normal and part of the process. It is important to try to understand where those thoughts are coming from and attempting to find ways to manage to move forward.

Remember, recovery is not a linear path, and it’s okay to take things one step at a time. Every step towards healing, no matter how small, is a significant achievement. Stay patient, be kind to yourself, and trust that you can overcome the obstacles on the road to recovery. You are not alone in this journey, and there is hope for a healthier and happier future ahead.

Dr. Joy Zelikovsky

Summer is a time for fun, spending time with family and friends and pools, and beaches. But for those struggling with body image concerns it can be very challenging to enjoy all those activities when you are concerned about how you look in summer clothes. The pressure to look a certain way, to look good in a bathing suit, to wear shorts or short sleeves, or to have parts of your body that you are not comfortable with more exposed can leave people in a lot of distress. The burden to look a certain way can make it difficult to enjoy all that summer has to offer. But there are things you can do to help boost your body confidence and enjoy your summer to the fullest! Here are five tips to help with body image during the summer:

1. Focus on what your body can do, not just how it looks. Instead of focusing on how your body looks in clothing, try to practice gratitude for what your body can do; whether it’s swimming, hiking, or playing beach volleyball. Remember that your body is more than just its appearance.
2. Surround yourself with positive influences. This may be a great time to look at your social media and reevaluate who you are following. Are those people uplifting you? Is the content focused on dieting and restriction or hyper-focused on bodies looking a certain way? Try to follow people who are spreading messages that make you feel good about your body. Likewise, who are you spending your time with? Are your family and friends supportive? Are they constantly talking about diets and bodies? It may be a helpful time to set boundaries and or discuss what is helpful to you.
3. Wear what makes you feel comfortable. You are not obligated to wear anything you don’t want to wear or that doesn’t make you comfortable. If you don’t want to wear a bathing suit, don’t wear one! If you prefer to wear shorts over your suit, wear them! If you want to wear shorts, wear them, if you want to wear jeans, wear them! You get to decide what you wear and when.
4. Practice self-care. Taking care of your body and mind can help boost your overall confidence and body image. Get enough sleep, stay hydrated, eat nourishing foods, and engage in activities that reduce stress.
5. Try not to compare yourself to others. You are not the only one who struggles with body image. As hard as it is, try not to compare yourself to other people. They may also be struggling with their body image concerns, or not, who knows, but most people struggle at some point in their life. No matter what, it won’t help you feel better about your body or doing activities that are fun for you.

Summer can be a difficult time, but you must remember that you don’t have to do anything you don’t want to. That includes wearing clothes you don’t want to wear or engaging in activities you don’t want to. However, challenging yourself to engage in things that you want to do and are exciting for you can be such a powerful experience. Most importantly, take care of yourself, set boundaries that work for you, and enjoy your summer!

Dr. Joy Zelikovsky

Eating disorders are complex mental health conditions that affect individuals from all walks of life. Eating disorders are the number two killer of all mental health diagnoses and impact people of all shapes and sizes, all genders, all sexual orientations, all ethnicities and races, and all incomes. However, while the symptoms associated with these disorders can be severe and have a profound impact on an individual’s physical, emotional, and psychological well-being, many individuals cannot or do not want to access traditional treatment programs for a variety of reasons.

More frequently clients have started to describe that treatment has been a traumatic experience for them, that they felt discriminated against due to their size, race, ethnicity, gender, or sexual orientation, and therefore were not able to fully get their needs met in treatment. Often, individuals in traditional treatment programs will explain that if they come from a marginalized culture their food was not represented in treatment or even villainized in treatment as less nutritious or “bad” for them. These experiences have left clients feeling like treatment programs are not viable options for their recovery if they need help with their eating disorders.

Finally, traditional treatment programs are prohibitively expensive for many people. Not all of them take all insurances or any insurance, or worse, insurance will often drop clients mid-treatment meaning they either have to leave or find a way to privately finance their treatment, which is not possible for most. This assumes that individuals can take the time off of work to attend treatment and have family or support to watch kids or pets if they have any and continue to pay any bills in the interim. There is often little to no financial support for those who want to recover in higher levels of care but need to continue to work to support themselves or keep their insurance benefits. Some treatment centers have begun to accommodate this and allow individuals some work and school time while in treatment, but often it is not enough.

An additional barrier to traditional treatment approaches is that they focus on complete abstinence from disordered eating behaviors. Many people find that while they want to reduce behaviors or the intensity of behaviors, they are not ready or are unwilling to pursue abstinence from their eating disorder, which for many, has been the only thing keeping them safe or functional. Therefore, the idea of going to a traditional treatment program where they will be asked to stop all eating disorder behaviors and will not be given certain privileges until they do so seems highly unappealing. So what is the alternative?

Harm reduction is an emerging practice, that while has been prominent in substance abuse treatment for many years, has not been as prominent in eating disorder treatment as a viable modality. However, it is a promising alternative approach that offers compassionate, non-judgmental support to individuals struggling with eating disorders.

Why is there a stigma around harm reduction in eating disorders?

One of the main reasons for the stigma surrounding harm reduction in eating disorders is the misconception that harm reduction strategies encourage disordered eating behaviors. This is simply not true. Harm reduction strategies aim to reduce the harm associated with disordered eating behaviors by promoting safety, dignity, and respect for individuals struggling with eating disorders. It is a process of meeting individuals where they are and working collaboratively to identify and address the underlying causes of disordered eating behaviors, harm reduction strategies offer a pathway to healing and recovery. By doing this, clinicians can help retain clients in treatment, foster motivation, and help clients make better decisions for their help and seek higher levels of care when and if they are ready.

Why is harm reduction important in eating disorders?

Harm reduction is important in eating disorders for several reasons. First and foremost, it acknowledges that complete abstinence from disordered eating behaviors may not be realistic for everyone and that progress toward recovery can take many different forms. Recovery is going to look different for everyone, it is important that clients feel like the door to recovery is not closed to them because they cannot access abstinence or do not want abstinence from behaviors. By offering judgment-free support and guidance, harm reduction strategies help individuals to feel empowered and motivated to work towards recovery at their own pace.

Harm reduction also promotes safety and reduces the risk of serious health complications associated with eating disorders, such as malnutrition, heart failure, and organ damage. By explaining to clients how to protect their dental health, heart health, and many other safety precautions they can take, we can safely re-engage clients in the medical system, as well as foster trust and safety with their teams. If clients choose to pursue more recovery at some point they are now engaged and have a support system available to them.

Finally, harm reduction emphasizes compassion and empathy, which are critical components of effective treatment and recovery. By prioritizing the needs and experiences of individuals struggling with eating disorders, harm reduction creates a safe and supportive environment for healing and recovery to take place. Before offering harm reduction work, clients were often met with ultimatums and being told their providers can no longer work with them. This did not motivate most clients to access higher levels of care. All it did was leave them without a team and continue to engage in dangerous symptom use. By openly discussing and engaging in harm reduction, it allows clients to access resources and stay with their teams so that they continue to have support and make positive changes at their own pace if they choose.

In conclusion, harm reduction is an important alternative approach to treating eating disorders that promotes healing, safety, and compassionate care. By breaking down stigma and offering non-judgmental support, harm reduction strategies offer a promising pathway to recovery for individuals struggling with eating disorders.